huckfinn

IsseyM- I agree with TakeTwo. The charge nurse will not let you get into trouble. Unless that person has a cowboy/girl mentality about emergencies. Nobody wants to get overwhelmed when the case gets tough. Remember your basic knowledge and put it to practicle use. All of the most advanced surgical procedures and emergency situations are dealt by switching your basic OR nursing knowledge application on autopilot and adjusting to the situations as they change. Most of all believe in yourself! Everyone can smell your self doubt and it makes them nervous!

Abdominal Aortic Aneurysm

I know of a CV SurgeryPA who got a blood drop splash in the eye. She was wearing safety glasses with side protectors but somehow the drop got around. The drop was infected with a herpetic virus. It blinded her dominant eye.

Technicare is a great bacteriocide. Too good actually. Be sure to wash the lady parts out with lots of water or saline after the case or your patient is likely to get a yeast infection. The sustained kill of the prep slows repopulation of normal flora which ofter leads to yeast growth. I can't believe anyone uses CHG or phisohex in the lady parts. Sure it does a nice job at killing germs but the labeling specifically contradicts use in mucous membranes. Don't invite a liability claim when you have other options!

Straight to the bone and wear Kendall knee high TED's when I can get the rep. to comp me some. Too expensive to buy. My legs really feel good after a 10 hour day on an epoxy over concrete OR floor. and now that I think about it I feel real sexy putting them on in front of all the studs I work with. But I do digress.....

Ferret, OH HO! The double en'tandre. Seriously...major lubrication helps the cath go in easier. Have you ever got the thing halfway in and hit a dry spot? Yes that applies to both situations. OUCH! Incidently, the lubrication/penetration bit came from a urologist. And, NEVER EVER cut the valve off to do routine draining of the balloon. That action removes your option of exploding a balloon with intentional over-inflation if you can't deflate with a syringe. Also a urologist's tip.

Tory, I'm curious. You are a nurse at only 19years old? That is an amazing accomplishment! So you graduated HS at 16 or 17 and then completed your AD and state boards by 19? Your school must not have had the multi-year waiting period to enroll in the nursing program. You are all that! Huck PS TO ALL: I find the whole catheterization thing much easier to handle mentally if you just think of it as another routine clinical procedure. Give good instructions, tell the truth about the discomfort;) :wink2: and get on with it. Always remember: Lubrication is the key to penetration!

Please read the spirited exchange from other members on this very subject. There is also a discussion on the AHVAP website. Remember to think about stringent gov. regs and science. Leave your emotions on the platform this is a wild ride. https://allnurses.com/forums/f39/re-sterilizing-off-pump-cabg-supplies-114768.html Huck

Get in contact with the manager of the OR at the place you would like to work. Applications go through HR and end up in the nursing pile, sometimes never to be forwarded to the OR. Get the contact info and make the call. You have everything to gain and who knows, they might need you right now and the OR folks don't even know you are out there. GOOD LUCK! Huck

The insuflators have a pressure control mechanism that adjusts the gas volume and pressure dependent on the machine settings. Anyway, have you considered the gas displacment of a 5 or 10 mm instrument? Multiply the length that is actually in the trocar by the instrument diameter. A 35 cm 10mm instrument would only account for 35ml of Fluid volume. 35cc ic not a lot of gas considering it takes several liters of gas to distend an abdomen. Does it take a clinical study and associated research report to make that statement? No offense intended on the CRAP statement, just my loss of impulse control in my quick reply. Huck

Joke: Do you know what the first thing a surgeon's spouse does with their a**hole when they wake up in the morning? Dress 'em up and send 'em to work.

For cleaning and steam penetration. The pressure equalization story is crap.

Offer them you credentials and additional abilities re: languages and anything else you think of that puts you ahead of the rest and then say you are only looking for day shift employment. If you really feel those are the only hours you are willing to take, say so! Otherwise you will get the offer you get. On the other hand.....if you really want to work there, tell them you will take what they have and option for the first available day shift position. You will need to understand that seniority and other special needs may put you way on the bottom of the shift change list. Whatever you decide, if they offer you the next opening on days from another less than desirable shift make them put it in print. Good Luck!

In surgery many a nurse will cut the balloon port off of a foley instead of aspirating the fluid out before pulling the cath out. I once saw a nurse pull on the foley and cut the whole thing. Up the cath stub shot into the bladder. Had to delay the crani until a urologist could be found to do a cysto to remove the retained foley piece. WOW>>>She never lived that one down!

Oncall, On the reprocessing of items-It is up to the clinical site as to use or not to use. The fact that the FDA certifying the individual items for the number of times it can be used, is a scientifically investigated process. Not just some guy saying I can resterilize this stuff and doing it. Some hospitals actually reprocess for themselves in accordance with the FDA guidlines. Who ever does this becomes the liable party. I hope you don't think the OEM is going to step up and say: "It is our fault." when a patient got injured while using their product. If there is a law suit everybody will be named and the oem will not send a lawyer to accept the blame or represent you. I also agree with you that a metal instrument is the best option economically. However, we use lots of disposable stuff where a reusable instrument is the better option financially. Are all of your docs using steel trocars? In my perfect world they do. Reality says they don't and won't. The reprocessors do know how the things are supposed to work and must assure that every piece works as specified. They have physicians and nurses on their staffs for consultation. Reprocessors are required to have all of the technical data and design information that the OEM used to make it and the item must leave the reprocessor meeting the exact OEM spec. Do you think the Malasian, Mexican, Brazilian or other third world native that works in the manufacturing facility knows how to use the thing they make and can assure that every one of the thousands they made that day work exactly as specified? No! The OEM is only required to select a sample from that batch and test those. They then either accept or reject the others in the batch base on the few tested. Again....reprocessors must check each and every item and accept or reject each one. Emotion of some of the parties posting here must be removed. Poopsiebear thinks reusing things is disgusting. Don't we reuse things every day? As far as liability goes-Thinking you are not liable for using a hopital processed re-usable instrument and you will be liable for using a reprocessed item is silly. Yes, a reusable device is the best option but not always possible. Sometime a disposable is required to be used. If it can be reused shouldn't it? It may be more economical to throw things away but due diligence is required before making those decisions, not just paranoia over liability issues and thinking reprocessing is disgusting.

Once I had this anesthesia doc who was pissed b/c the aids didn't hop to when he ordered them to fetch a prep table to put his non-surgery related laptop on. I asked him if he planned on returning it to it's assigned place when he was through for the day. He escallated and started loud whining and complaining, slamming stuff about and getting nasty about my questioning his omnipotence and personal intentions.......I covered my ears and started singing "I can't hear you. I can't hear you." and continued until his jaw fell to the floor and he was quiet. I then offered that if I behaved in the same manner in which he is accustomed to behaving and spoke to others as he does, I would be fired and in some environments arrested for threatening and unruly behavior. And I refrained from doing so at this time for those reasons. I then proceeded to tell him that I would appreciate the same attitude and treatment he expected to receive. I repeated and allowed him to answer my original question as to intention of returning the prep table to it's assigned room when he was finished. Not only did he return the table when he was done for the day, but had a case of Harry and David pears sent to my home, offered me his box to see The Phantom of the Opera when it toured in our area and has treated me with the highest respect from that event to present (several years). Writing people up for their inappropriate behavior will get you more of the same as well as contempt from those who hear the stories ABOUT YOUR IMPOTENT ACTIONS. TELL THOSE JERKS WHAT BEHAVIORS YOU EXPECT AND ACCEPT NOTHING LESS! THEIR MOTHERS WOULDN'T STAND FOR THEIR RUDE BEHAVIORS AND YOU SHOULDN'T EITHER! Nuff sed.

The FDA certifies companies to provide reprocessed "single use" supplies. The certification requires validations that the item meet or exceed the original equipment manufacturer (OEM) specifications for that product as indicated in the original FDA approval to the OEM. Also required is that the item is proven to be sterile. Also that the reprocessor carry liability insurance to cover any adverse situations related to the use of the product. In effect the reprocessor becomes the OEM for that product and assumes all liability for it. In some instances I think the reprocessed item is better than a new one. OEM usually only tests a certain quantity in a product batch and then claim the batch to be acceptable. Have you ever had a brand new product fail right out of the package and wonder WHY? Ever heard of product recalls?The reprocessor must test each product and certify it as meeting the OEM specs for form and function. With that being understood and done under the strict supervision of the FDA, reprosessing makes sense. The previous arguments for not using reprocessed products lead me to ask the questions......Why are we using surgical instruments over and over and not asking the same questions regarding their cleanliness, expert tested quality certified and sterility? Are your processing techs factory trained quality control experts? Isn't the lumen of a mini ureteroscope only 1mm or less and 40cm long? There aren't brushes to fit down those things. Do your instuments ever come out of a "sterile" package from processing with valves closed, clamps locked and scissors closed? Do you refuse the entire set or just the ones that don't "seem" OK because you don't want to tell the doctor that the entire set will need to spend 2 hours in processing to meet your standard of care issues while you wait with the patient asleep on the table? Consider just flashing it you say?????...You didn't flash for every other case that day or even every other item used for that case! OK! My sleep deprived rant is finished. I am not invested in nor do I work for a reprossing company. I am a 20 year OR Nurse veteran. I am proud to say I am now a Healthcare Value Analysis Professional! My goal is to make healthcare affordable. Isn't it a shame that caregivers can't afford to buy their own product because of BIG MEDICAL SUPPLY MANUFACTURER. MEDICAL INSURER AND PROFESSIONAL LITIGATOR GREED? Give me a properly reprocessed item any time. At least I know it has been tested once and worked correctly! HUCKwww.ahvap.org

[/b] Thou Shalt Not Whine!

Yes. Doing the show with Rachael Ray would be way too much fun. Cooking up a wonder to rival Bobby flay would be supreme. Shouln't be too hard...he usually has char all over his dishes anyway. Don't think I could ever get used to eating carbon with every meal. Tips....Don't store your acidic foods in metal cookware. It pits the surface. NEVER NEVER NEVER use soap to clean your iron pots and pans. It ruins the seasoning you have worked so hard to build, makes them rust and imparts a funny taste to everything you cook in it until properly seasoned again. Like Emeral (sp?) says pork fat is a good thing!!!

Mike, Perhapse your infection control pratitioner or OR Educator could help you out. There is also a vast resource at AORN. They usually have an article on the subject annually. AJN and other professional journals also address this from time to time. GOOD LUCK! TAKE ACTION TO IMPROVE YOUR DEPARTMENT PRACTICES! If you don't you'll be letting your patients and all the rest of us down.

Grimmy, Have you ever read the contents of a shurclens prep container? NO ANTIMICROBIAL or MICROBIOCIDAL AGENTS there! Not much more than purified water. Using that to prep before going throught that staph ridden nose and into the brain? How do you avoid infections? Shurclens should only be used for removal of gross contaminants from trauma and other "dirty" type precleaning. Maybe your docs don't really know what they are asking for when they request the stuff. OR Nurses often find these things out when they investigate the rationale for a doctor's choice of one solution over another. Surgeons are often very greatful, when educated about their choices. It demonstrates that you have their patient's best interest and positive outcome in mind. Boy, and won't you be the model of patient advocacy!

Do all of you who use alcohol allow the use of electrosurgical devices? There is an incredible fire hazard there! CHG and PCMX should never be used on mucous membranes. Phisohex is known to cause cancer. All prep solutions should be allowed to dry on the skin before draping...how many surgeons are willing to watch the stuff dry? NONE! WOW so many restrictions! We use Betadine Paint for all lady partsl procedures and urological unless there is a sensitivity. Technicare is another good one and is OK to use on mucous membranes and open wounds. Additionally, it is not rendered inactive by blood as betadine is. Technicare has it's down side. NOTHING will stick to the skin after it has been applied. It does such a good job at killing microbes that unless extra care is taken to rinse it out of the lady parts, the patient ends up with a yeast infection. I still like betadine the best.

Keep your eyes open and be careful. I would worry about getting sucked into her "syndrome" as a co-dependent.

Check out the Ohio Board of Nursing site. It has the ce requirements and qualifications for re-liscensure. There may also be some information about nclex question. Good Luck!

I too worked about 5.5 mos on an endocrine diagnostics and resp. dump floor. No one would hire a new grad to surgery at that time and if you could believe it a hiring freeze for nursing with a local glut of grads looking for jobs. Immediately after taking report every day I would go to the hall phone and hammer the surgery super for a job. Finally got one and have been in OR for 19 yrs. If I couldn't do this for a living I would kill myself.